Temporizing Aortic Valve Repair In Small Children
Andrew C. Fiore, MD1, Charles B. Huddleston, MD1, Christopher E. Mascio, MD2, Vinay Badhwar, MD2, J. Scott Rankin, MD2.
1St. Louis University, St. Louis, MO, USA, 2West Virginia University, Morgantown, WV, USA.
Objective: Developing better methods of aortic valve repair in childhood could provide a definitive solution, or at least temporize clinically until a long-term repair with an adult annuloplasty ring or aortic valve replacement becomes possible.
Methods: The patient was an 8 year-old male with coarctation repair in early childhood and balloon aortic valvuloplasty at age 6 years for an obstructed unicuspid valve. He developed severe aortic insufficiency and congestive heart failure from a torn leaflet. The R-L commissure was the major fusion, while the R-N was the minor fusion - the most common unicuspid anatomy. The right aspect of the fused R-L cusp was torn, with inadequate leaflet. The non-fused free-edge length (FEL) was 22 mm. With the goal of reducing annular diameter to 15 mm (FEL/1.5), subcommissural annuloplasties were placed to a measured annular diameter of 15 mm.
Results: A 10 mm pericardial patch was fashioned to fill the fused leaflet defect (we now would use autologous aortic wall for leaflet patching). The patch was sutured to the rim of the defect with interrupted 6-0 Prolene sutures, and the non-fused reference cusp was plicated to match, creating equal leaflet lengths and effective heights. After repair, the leaflets moved well, with a good orifice, trivial residual leak, and a 16 mmHg mean gradient - all stable at 3 years.
Conclusions: Better techniques for childhood aortic valve repair would be useful, and might either provide a stable long-term solution, or allow later definitive repair with an adult annuloplasty ring.
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